In talking to friends, relatives and colleagues about their insulin disorders (including stage one/prediabetes), and reading hundreds of threads on online diabetic forums, there appears to be a preponderance of substandard health advice being given by well-meaning physicians world-wide. Of course there are exceptions (I have experienced the norm and the exceptions), but it’s highly likely you’re getting suboptimal advice from the medical establishment.
It pains me to learn just how many people put all of their faith in physicians, when the vast majority of these physicians typically look at diabetes through the diagnostic and therapy lens vs. the actions-and-consequences of life management lens. This is, unfortunately, quite understandable: diagnosis and therapy is the job of a physician, and it is not the job of a typical physician to ensure that the patient fully understands precisely the science behind the diagnosis and the therapy. Many physicians do not feel accountable for ensuring that their patients understand the fundamentals behind the diagnosis and therapy, and most patients are fine with this. They just want to know what to do.
In the case of diabetes (and likely many other disorders), this leads millions of people to “follow doctor’s orders” without understanding why, which unfortunately leads to horrific outcomes, including 60%-70% of people with insulin disorders experiencing nervous system complications.
One infuriating trend I’ve witnessed is doctors refusing to fulfill prescription requests for continuous glucose monitors (CGMs) for patients with insulin resistance disorders (i.e., type 2s). I have friends and family with insulin resistance disorders who I have strongly encouraged to request a CGM from their doctors. Sadly, exactly zero of their doctors will prescribe them. Why? Because “what you have isn’t as serious as type 1 diabetes so it’s overkill.” Meanwhile, these people’s A1c’s range from 6.3 to 7.3, and here I am, the “more serious type 1” with an A1c of 5.4. Why? Because I have a CGM! Knowledge is power, people. Why do doctors want to disempower patients just because of the specific flavor of their insulin disorder?
Another concerning trend I’ve seen is that while an A1c of 6.5% or higher officially designates someone as diabetic, once diagnosed diabetic, the healthcare industry suddenly recommends A1c’s “under 7%” or even “under 8%,” depending on the source.
Yet if we look at the evidence (see chart below), notice how 7% A1c nearly doubles the chances of diabetic complications? Remember: some doctors tell their patients that they’re “successful” if below 8%!
A study released in 2020 (see chart below) not only re-enforces this issue, but takes it a step further:
Diabetes Care 2020 Apr; 43(4): 894-902.
What we see in this study confirms the Type A Diabetic Manifesto hypothesis: so-called diabetic complications aren’t based on diabetes — they are based purely on the severity of glucose imbalance. This study drives this point home by showcasing that people at the low-end of so-called prediabetes (with an A1c of ~5.8%) have a 2x hazard ratio for developing retinopathy (retina disease) and diabetic nephropathy (kidney disease).
Re-read that previous sentence and let it sink in: We have a condition termed “diabetic nephropathy” yet it can impact people who have elevated glucose levels but are not considered diabetic. In case you had any doubt that the terms diabetes and prediabetes creates more confusion than clarity, this should put any doubt to rest.
These two charts, representing research spanning three decades, paints a clear picture: Complications are linearly correlated with elevated blood glucose, and begin well below the current “diabetic diagnostic” threshold of a 6.5% A1c.
The implications of this are clear:
- There is no on/off switch for diabetes, which re-enforces why the term diabetes should be retired. The issue at hand is actually glucose toxicity, as the level of glucose in the blood is directly and linearly correlated with health complications.
- Due to our diagnostic desires to have magic number thresholds, there are potentially millions of people that have harmful A1c levels who are being diagnosed as “pre” disease state (i.e., prediabetes), and perhaps millions more who are considered to be in a healthy range.
- Due to “grading diabetics on a curve,” how many diabetics that are currently being managed to 7-8% A1c levels will experience some kind of complication? The research does not paint a rosy picture.
I understand the psychology behind the strategy of managing reasonable expectations across millions of patients. Many diabetics are initially diagnosed with 10-15% A1c levels, so reaching 7% or 8% A1c levels is a tremendous accomplishment. And doctors want to keep patients engaged by giving them reasonable targets. However, because the average patient doesn’t understand what the A1c really is, how it relates to hourly glucose levels (and spikes), and how this links to future complications, they go on their merry way happy that they’re meeting their doctor’s expectations.
But if every diabetic patient knew what was going on, why it was happening, what the risk factors truly are, and how the therapy was addressing the issue, each patient would have a better chance of understanding how to ensure they could maintain a healthy glucose equilibrium, which would reduce painful, costly, and even deadly glucose toxicity-related complications.
Unfortunately, in my experience, what I hear overwhelmingly from diabetics and pre-diabetics alike is “my doctor thinks I’m doing great!” Case closed. They are not interested in understanding why their doctor may be steering them down a potentially unhealthy path, and leading them to unnecessary and potentially debilitating pain, discomfort, and disabilities.
The result? Healthcare systems are being unnecessarily taxed by a diabetes epidemic. In America, there are countless stories of people who cannot afford to buy insulin, and even die as a result. Has anyone thought about completely changing how we deal with insulin disorders so that there would be less medical care needed, and less insulin needed? Read on to see how this is absolutely achievable.